Brigham and Women’s Hospital
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Hyperthermic intraperitoneal chemotherapy (HIPEC) is a two-step treatment for peritoneal mesothelioma. Doctors first use cytoreductive surgery to remove tumors. Then, they wash the abdomen with heated chemo drugs. This method kills the remaining cancer cells.
Written by Karen Selby, RN | Medically Reviewed By Dr. W. Charles Conway | Edited By Walter Pacheco | Last Update: October 16, 2024
HIPEC is a procedure that combines surgery with heated chemotherapy for treating peritoneal mesothelioma. The two-part process removes tumors and then washes the abdomen with high doses of chemo drugs to treat any tumor cells left.
HIPEC directly targets where mesothelioma tumors develop. Local chemo targets cancer cells more than normal cells. This prevents chemotherapy resistance.
HIPEC combines tumor-removing surgery and heated chemotherapy. First, cytoreductive surgery removes as much of the peritoneal mesothelioma cancer tumors as it can. Next, heated chemotherapy drugs are directly applied to the abdominal cavity.
HIPEC surgery eases symptoms of mesothelioma and extends life. CRS plus HIPEC improves survival more than any other treatment for peritoneal mesothelioma.
CRS with HIPEC works better than standard chemo for peritoneal mesothelioma. It also has fewer side effects. Traditional chemotherapy affects the whole body (systemic). HIPEC only uses local chemotherapy. It targets the cancer’s specific location. Also, HIPEC heats the chemotherapy drugs. This lets cancer cells absorb them better.
A mesothelioma cytoreduction aims to remove as many peritoneal mesothelioma cancer cells as possible from the abdomen. Both radical and minimally invasive CRS can improve survival in the right patients. They do so equally.
This includes all visible tumors. Radical or extreme CRS is often used to remove tissue likely to have cancer cells. This can include removing part of the lining of the abdomen (peritoneum removal in a peritonectomy). Surgeons may also remove part of the intestines, the greater omentum and some lymph nodes. The greater omentum is the fatty tissue covering the organs.
Research shows for some patients minimally invasive CRS may be a good option. This is true for those with a low peritoneal cancer index. Some studies say that less invasive surgery leads to shorter hospital stays. There are also fewer surgical complications.
Right after surgery, mesothelioma doctors use heated chemo to kill any remaining peritoneal mesothelioma cancer cells. Chemo drugs bathe tissue in the abdominal cavity. A HIPEC machine heats the chemotherapy drugs. It then circulates them through the abdomen using catheters. The machine pumps the drugs into and out of the body.
The procedure usually takes 1 hour to deliver chemotherapy. Once HIPEC is complete, surgeons drain the drugs. They then rinse the abdomen with saline before closing the incisions.
Doctors look for patients who are otherwise healthy except for their cancer diagnosis. They conduct assessments to determine a patient’s overall health, which they call performance status.
A 2021 research study by Dr. Paul Sugarbaker determined that age had the greatest impact on survival following a HIPEC procedure. Contraindications of HIPEC can include severe chronic illnesses, heart disease and liver disease. A diagnosis with epithelial cell type improves the chances that HIPEC will be effective.
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Connect NowThe risk of side effects from chemotherapy and HIPEC for peritoneal mesothelioma is 4.5% to 19%. HIPEC surgery usually has fewer and milder side effects than chemo.
Most chemotherapy side effects are minor. But serious complications can occur. In some patients, HIPEC can cause kidney and liver damage. It may also lead to metabolic imbalances and bone marrow suppression. Other issues can affect the digestive and circulatory systems.
Common Side Effects of HIPEC
Serious HIPEC complications are rare. However, there can be bleeding, clots, infections, and sepsis. There can also be leaks in the intestines, kidney failure and pancreatitis.
Research shows that a protein’s rise after HIPEC can predict poor outcomes. High C-reactive protein levels may mean a higher risk of complications.
Several factors affect who will benefit most from the two-part HIPEC treatment and have fewer side effects. HIPEC is best for younger, healthy patients. They must be able to endure a long surgery and recovery.
Eligibility also depends on how far tumors have spread beyond the abdomen. The chance of success in surgery depends on removing all cancer cells.
Patients who are healthy except for their cancer are more likely to qualify. Doctors will assess your health or performance status. Dr. Paul Sugarbaker’s 2021 study found age had the greatest impact on survival after HIPEC.
HIPEC isn’t advised for people with severe chronic illnesses, heart disease or liver disease. People with tumors in some abdominal areas aren’t good candidates. HIPEC for mesothelioma is more effective on the epithelial cell type.
Patient Advocates at The Mesothelioma Center can help you. They can connect you with centers that treat mesothelioma with HIPEC surgery. Many U.S. mesothelioma centers don’t offer HIPEC as a standard treatment. CRS is complex and needs specialized HIPEC equipment.
75 Francis St, Boston, MA 02115
Year Built: 1832
Number of Beds: 793 beds
Number of Physicians: 5
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Year Built: 1979
Number of Physicians: 2
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Year Built: 1986
Number of Beds: 206 beds
Number of Physicians: 10
1 Gustave L. Levy Pl New York, NY 10029
Year Built: 1855
Number of Beds: 1,144 beds
Number of Physicians: 4
620 Howard Ave, Altoona, PA 16601
Year Built: 2013 (became part of UPMC)
Number of Beds: 380 beds
Number of Physicians: 1
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Year Built: 1983
Number of Beds: 473 beds in main hospital
Number of Physicians: 4
You can schedule a surgical consultation to learn more about HIPEC and whether you qualify. During a consultation, you can meet with the surgeon and surgical team members either virtually or in person. This gives you the opportunity to ask questions and address any concerns you have with the team.
The surgical team then reviews your medical records to determine if you qualify. If so, the surgeon will discuss the risks and benefits of surgery with you. You will learn more about the surgery, including how to prepare and what to expect during recovery.
Recovery from HIPEC surgery typically takes from 4 to 12 weeks. The more extensive the surgery, the longer the recovery. Many patients need a feeding tube during recovery. HIPEC surgery causes a temporary stop in bowel function.
After HIPEC surgery, you’ll stay in the hospital until your bowels function again. This usually takes at least a week. This can include spending time in an intensive care unit. During your recovery, doctors will run tests and scans. They will check your recovery and response to HIPEC surgery.
It’s been 16 years since I received HIPEC surgery. Then it seemed as if the odds were against me. I didn’t let the diagnosis define me nor did I take no for an answer.
Some medical centers use a protocol for “enhanced recovery after surgery.” This approach can improve pain control and cut recovery time.
HIPEC surgery significantly improves life expectancy. This includes both overall and progression-free survival. The 5-year survival rate for peritoneal mesothelioma is as high as 69% after HIPEC surgery.
Research shows life expectancy after HIPEC surgery is 53 months. This increases to 103 months for patients with better PCI scores. A March 2022 study found repeat HIPEC surgery patients survive an average of 67.7 months, or 5.6 years.
Earlier studies had mixed success. Some reported great success even two decades ago. For example, 87% of stage 1 peritoneal mesothelioma patients had a 5-year survival rate after HIPEC in a 2011 study. A 2003 study found HIPEC surgery had a median survival of 92 months, or 7.6 years, for all stages combined.
Patients often report pain after surgery with HIPEC. It’s usually temporary. They may have pain from surgical incisions and inflammation. Neuropathic or nerve pain may also occur.
Cytoreductive surgery with HIPEC costs about $38,000 to $49,000. A 2024 study study in the Annals of Surgical Oncology found that the median direct cost for CRS and HIPEC was $44,700.
HIPEC surgery has a 1.1% mortality rate. It’s lower than other high-risk cancer surgeries. A 2020 study in the International Journal of Clinical Oncology supports this. It found the rate of serious complications after HIPEC surgery was 14.7%.
Hyperthermic intrathoracic chemotherapy is available. HITHOC delivers chemo directly to the pleural lining around the lungs.
The late Dr. David Sugarbaker led a study that reported improved survival with HITHOC. For patients who qualified for surgery, survival improved by 12.5 months.
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Selby, K. (2024, October 16). HIPEC Surgery for Mesothelioma. Asbestos.com. Retrieved October 28, 2024, from https://www.asbestos.com/treatment/chemotherapy/hipec/
Selby, Karen. "HIPEC Surgery for Mesothelioma." Asbestos.com, 16 Oct 2024, https://www.asbestos.com/treatment/chemotherapy/hipec/.
Selby, Karen. "HIPEC Surgery for Mesothelioma." Asbestos.com. Last modified October 16, 2024. https://www.asbestos.com/treatment/chemotherapy/hipec/.
A medical doctor who specializes in mesothelioma or cancer treatment reviewed the content on this page to ensure it meets current medical standards and accuracy.
Please read our editorial guidelines to learn more about our content creation and review process.
Surgical oncologist and peritoneal specialist Dr. W. Charles Conway is director of surgical oncology at the Ridley-Tree Cancer Center in Santa Barbara, California. He specializes in gastrointestinal cancers and peritoneal surface malignancies, including mesothelioma.
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